Dexmedetomidine in cardiac anesthesia

There is an ever increasing number of invasive cardiovascular procedures performed annually all over the world. Most of these procedures are known to have a high complication rate; the most common cause of these complications being the surgical stress response with resultant impaired myocardial oxygen supply and demand ratio. The use of dexmedetomidine in cardiac anesthesia has shown promising results in decreasing the complication rates in these patients. It is shorter acting, highly selective alpha-2 adrenoceptor agonist and has analgesic, sedative, anxiolytic and sympatholytic properties. Published studies and meta-analyses have demonstrated beneficial role of perioperative use of dexmedetomidine in cardiac anesthesia. It is relatively a new drug and in order to further confirm its beneficial effects during cardiac anesthesia, more well designed, clinical trials are needed to make evidence based recommendations for its use in specific circumstances and establish its permanent place in cardiac anesthesia

Prepare today for tomorrow

There has been a rapid advancement in cardiac surgery and anesthesia recently. The burden of cardiothoracic disease in south East Asia especially in Pakistan is on the rise. To meet the challenges of future, the present day cardiologist, cardiothoracic surgeons and cardiothoracic anesthesiologists should be equipped with knowledge and expertise to train work force for future capable to treat the burden of cardiothoracic diseases. The future of cardiothoracic surgery and anesthesia is dependent on the advancements made in recent years in this specialty. It is time that the cardiothoracic anesthesiologists of the country embrace technologies such as transesophageal echocardiography and extracorporeal membrane oxygenation so that they can help in providing safe anesthesia and post-operative care for complex cardiothoracic operations

Association of sensory polyneuropathy with restless legs syndrome

Objective: To determine the prevalence of restless legs syndrome [RLS] in elderly patients with pure sensory polyneuropathy and correlate the findings with other clinical features

Study Design: Observational / cross sectional study.Place and Duration of Study: This study was conducted at the Dow University Hospital and Civil Hospital Karachi from 2013 to 2015

Materials and Methods: 48 patients with Restless leg syndrome were evaluated in our multicenter, prospective study in 2 years for evidence of pure sensory neuropathy either they have demyelinating or axonal type. Patients were evaluated according age at which symptomsstarted, the severity of symptoms, typical clinical findings and laboratory investigations

Results: In 21 of the 48 [43.7%] patients, peripheral neuropathy was detected. Ten patients had pure sensory polyneuropathy and remaining have mixed sensory motor polyneuropathy. The pure sensory neuropathy group had comparatively intense and frequent symptoms of Restless leg syndrome. Some of them have family history of Restless leg syndrome. Patients with Mixed sensory motor polyneuropathy did not have similar strong symptoms of Restless leg syndrome and pain in legs

Conclusion: The result suggests that Restless leg syndrome is triggered by painful paresthesias is primarilyrelated with pure sensory neuropathy. Patients with mixed sensory motor neuropathy have less intense feature of restless leg syndrome. So the treatment options should be focused on medicines used for neuropathic pain

prevalence of iron deficiency anemia in female medical students of different medical colleges of Khyber Pakhtoonkhwa, Pakistan

Objective: Iron deficiency anemia [IDA] is very common in adolescent and adults, especially female. In medical students, it is caused by a number of causes, "including overwork, decrease appetite due to stress and unnecessary dieting". Very little data is available at national level about these health conscious medical students. This "descriptive, cross sectional study, was conducted in public and private Medical colleges of KPK". The main objective of the study was "to determine the Prevalence of IDA in female medical students of KPK"

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the department of Pharmacology, Khyber Girls' Medical College, Peshawar From December-2015 to May-2016

Materials and Methods 390-female medical students aged 19 to 24 years have participated in this study'. After formal consent and recording of their demographic information, "Hemoglobin [Hb] and Mean Corpuscular Volume [MCV] was done using digital Sysmex XT-4000i hematology analyzer". Serum ferritin [S-Ferritin] was done using Architect I-2000 analyzer. The identity of all students was kept confidential. All students with, "Hb<12g/dl, MCV<76um [3] and S-Ferritin <11ng/ml were labeled as having IDA and students having Hb>12g/dl, MCV>76um [3] but S-Ferritin<11ng/ml were labeled as having Iron deficiency [ID], but not IDA"

Results: Complete data of all "390 students were available for further analysis". The mean age of the students was 21 +/- 1 years. IDA was present in 6.66% [n=26/390] students, while ID was present in 41.54% [n=162/390] students. Normal iron status was found in 51.80% [n=202/390] students

Conclusion: It is concluded that "ID and IDA are very common in female medical students of KPK. All female medical students should be encouraged to take extra iron to replenish their iron store"

Developing local guidelines for management of sepsis in adults: sepsis guidelines for Pakistan [SGp] endorsed by global sepsis alliance

The purpose of developing [Sepsis Guidelines for Pakistan] [SGP] is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign [SSC] tailored to available resources. These recommendations are not meant to replace the SSC Guidelines. SGP is an initiative of Pakistan Society of Critical Care Medicine [PSCCM]. Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committeei.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, essential interventions to manage sepsis, and general measures for provision of a comprehensive care to patients in sepsis according to the level of education and training of healthcare providers and facilities and resources available in different levels of hospitals. The draft was presented at the 3[rd] Sepsis Symposium held on13[th] September, 2014 in Karachi. The final document was approved by a panel of experts from across the country, representatives of relevant societies and Global Sepsis Alliance [GSA]. Hospitals are divided into basic, intermediate and tertiary depending on the availability of diagnostic facilities and training of the medical personnel. Modified definitions of sepsis,severe sepsis, and septic shock are used given the lack of facilities to diagnose sepsis according to international definitions and criteria in Pakistan. Essential interventions include fluid resuscitation,vasopressors to support the circulation, maintaining oxygen saturation >/= 90% with oxygen, non-invasive ventilation or mechanical ventilation with lung protective strategies, prompt administration of antibiotics as recommended by the Medical Microbiology and Infectious Diseases Society of Pakistan [MMIDSP] and early source control. It is recommended to avoid starvation, keep an upper blood glucose 7.20, avoid fresh frozen plasma in the absence of bleeding, transfuse platelets if indicated, not use intravenous immunoglobulins and avoid neuromuscular blocking agents [NMBAs] in the absence of ARDS, target specific titration endpoints when continuous or intermittent sedation is required in mechanically ventilated patients and use continuous renal replacement therapy [CRRT] to facilitate management of fluid balance in hemodynamically unstable septic patients in tertiary care centers. In addition a comprehensive, meticulous and multidisciplinary general care is required to improve outcome of sepsis by reinforcing hand hygiene and other infection control measures, adequate monitoring and documentation tailored to the available resources. Goals of care and prognosis should be discussed with patients and families early and either shifting the patient to a hospital with better facilities or limiting or withdrawing therapy in case of poor prognosis should be considered

Are BP readings taken after a patient-physician encounter in a real-world clinic scenario the lowest of all the readings in a clinic visit

To determine the difference in Blood Pressure [BP] readings taken before, during and after the clinic encounter. Descriptive study. Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013. Hypertensive and normotensive participants aged >/= 18 years were recruited. Pre-clinic BP was measured by a nurse and in-clinic BP by a physician. After 15 minutes, two post-clinic BP readings were taken at 1 minute interval. All readings were taken using Omron HEM7221-E. Out of 180 participants, males were 57% and 130 [71%] were hypertensive. Mean SBP [Systolic BP] taken preclinic, in-clinic, post-clinic 1 and post-clinic 2 were: 126 +/- 20 mmHg, 131 +/- 23 mmHg, 126 +/- 20 mmHg and 121 +/- 21 mmHg respectively [p < 0.001]. Mean DBP [Diastolic BP] taken pre-clinic, in-clinic, post-clinic 1 and post-clinic 2 were 77 +/- 12 mmHg, 81 +/- 13 mmHg, 79 +/- 12 mmHg and 79 +/- 11 mmHg respectively [p < 0.001]. BP taken in the post-clinic setting may significantly be the lowest reading in a clinic encounter, making in-clinic BP unreliable to diagnose or manage hypertension

Gulf implantable cardioverter-defibrillator registry: rationale, methodology, and implementation

Background: The implantable cardioverter-defibrillator [ICD] is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region

Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates

Results: Fifteen centers in six countries are enrolling patients [Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar]. Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of

Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region

APACHE II analysis of a surgical intensive care unit population in a tertiary care hospital in Karachi [Pakistan]

Performance of prognostic models deteriorates over time by changes in case-mix and clinical practice. This study was conducted to describe the case-mix of a surgical intensive care unit [SICU] and assess the performance of APACHE II scoring system in this cohort. We analyzed 213 adult patients admitted to the surgical intensive care unit [SICU] of Aga Khan University Hospital, from January 2011 to December 2012 and the performance of APACHE II scoring system was assessed in this population. The mean age of patients was 46.31 years [SD +/- 18.43], 67.1% patients were male and mean length of ICU stay was 6.54 days [SD +/- 7.18]. Admissions to SICU were from seven service departments with the highest admissions from general surgery followed by trauma and neurosurgery. The mean APACHE II score of this SICU population was 15.89 [SD +/- 8.06], 12.88 [SD +/- 6.29] in survivors and 22.24 [SD +/- 7.66] in non-survivors [p <0.01]. The overall mortality was 33%, with SMR of 1.0. No patient survived with an APACHE II score of more than 34. In this SICU population the calibration and discrimination of the APACHE II scoring system was acceptable, i.e. [[H-LS 11.76 [p=0.l6]] and [area under the receiver operating curve = 0.83]. APACHE II scoring system allows meaningful analysis of SICU population, therefore, it is recommend, that this simple and cost effective scoring system should be used to identify patients with high risk of death to justify the decisions of withholding expensive therapies in resource limited settings

review of critical care management of maternal sepsis

Sepsis is a leading cause of preventable maternal mortality in developing countries due to poverty, home deliveries by untrained persons in unhygienic conditions, limited access to healthcare facilities and lack of availability of antibiotics. Recent confidential enquiries into maternal deaths from the developed nations have revealed an increase in maternal mortality secondary to genital tract sepsis and provision of suboptimal critical care. Early recognition of critical illness in obstetric patients, involvement of intensive care teams earlier and provision of same standard of critical care to pregnant women as non-pregnant patients while being mindful of the altered maternal physiology and fetal wellbeing is necessary to improve outcome of this vulnerable population.This article reviews the definitions and risk factors of maternal sepsis and describes the standards recommended for efficient delivery of maternal critical care and sepsis management

Diuretic induced hyponatremia in hypertensive patients

Diuretics are the recommended antihypertensive by several international guidelines. This study was designed to determine the association of hyponatremia in hypertensive patients on diuretic therapy. This was a case control study conducted at the Aga Khan University Hospital, Karachi in adult inpatients [> 18 years] who were known hypertensive. Cases were defined as hypertensives with hyponatremia and controls were defined as hypertensives without hyponatremia. Outcome was hyponatremia. Exposed were those using diuretics. Out of 1800 hypertensive patients sampled by the ICD-9-Coding; 1191 [66%] fulfilled the inclusion criteria. Cases n [%] were 553 [46.4] and controls were 638 [53.5]. Among 553 cases [%] 180 [32.5] were exposed [on diuretics] and in controls 189 [29.6] were exposed [on diuretics] p=0.15. The association of hyponatremia with diuretic use was not significant with OR=1.11 [95% CI=0.86 - 1.45, p=0.40], after adjusting for chronic kidney disease, ischemic heart disease and chronic liver disease, in the final model. Diuretics were not associated with hyponatremia in hypertensive adult patients in this study

Better physician-patient communication; an important milestone in control of hypertension, a multicenter study from Karachi, Pakistan

Control of hypertension is an important cornerstone in prevention of cardiovascular morbidity and mortality. This study was designed to compare physician encounter score in patients with controlled and uncontrolled hypertension. It was conducted at three tertiary care hospitals in Karachi. Patients were categorized into controlled and uncontrolled hypertension based on their initial blood pressure readings on presentation. Primary outcome variable was control of hypertension and physician encounter score [a composite score of 12 item question] was the main candidate variable. Higher scores reflected favorable encounter with physician. Mean age of participants was 57.7 +/- 12 years; 224 [50.1%] were men. Controlled hypertension was present in 72.3% [323] and uncontrolled hypertension was present in 27.4% [124]. Mean physician encounter score in uncontrolled hypertensive was 7.25 +/- 2.64 versus 7.83 +/- 2.22 [p=0.02] in controlled hypertensive. Patient-physician encounter is an important milestone in control of hypertension in hypertensive patients and directly translates into better adherence to antihypertensives in these patients

Validity and reliability testing: Urdu translated modified response to symptoms questionnaire

To determine validity and reliability of the Urdu translated, modified "Response to symptoms questionnaire" [RSQ] among acute coronary syndrome [ACS] patients in Karachi. A qualitative, tool validation study. Two tertiary care hospitals in Karachi, the Aga Khan University Hospital, Karachi and the Karachi Institute of Heart Diseases, from December 2010 to April 2011. After making certain modifications, the original tool in English was translated into Urdu. Next, five cardiology experts evaluated the tool for its content and face validity. Test retest and inter rater reliabilities were computed for the RSQ using 5% of the total sample size of the parent study. Sufficient conceptual and semantic equivalence was found between the Urdu and English versions of the modified RSQ. Content validity index was calculated to be 1 for both relevance and linguistic clarity. Test retest and inter rater reliabilities were calculated to be 95.9% and K = 0.97, respectively. The Urdu translated modified RSQ has sufficiently acceptable content validity, test retest and inter rater reliability; hence, it should be used by the researchers for the evaluation of factors associated with pre-hospital delay among Urdu speaking ACS patient populations

MRI features of spinal fluorosis: results of an endemic community screening

Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Randomly selected adults from the Village Samorindh, district Thar parker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 +/- 10.45 years; 21 being male [77.8%]. The most frequent findings included generalized vertebral sclerosis [24, 88.8%], ligamentum flavum hypertrophy [23, 85%], anterior [20, 74%] and lateral [17, 62.9%] disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04[14.8%]. The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings

Type 2 diabetes; effects of socio-demographic factors among patients

To determine the effects of various socio-demographic factors upon the prevalence of diabetes mellitus. Type 2 Diabetes is growing at an epidemic scale. Besides genetic predisposition, numerous environmental factors elicit the development of diabetes. An estimated 246 million people are suffering from diabetes worldwide. Majority of diabetics [80%] live in very poor countries of the world, where even the least expensive lifesaving diabetes drugs are not available. Pakistan ranks number seven in terms of global diabetes burden and is projected to reach number five in 2025. Approximately half of the diabetics are aware of their disease status, and most of them are diagnosed with complications and poor metabolic control. This study determines the effects of various socio-demographic factors upon the prevalence of diabetes mellitus. Cross-sectional. National Institute of Diabetes and Endocrinology, DUHS, Karachi, Pakistan. March 2008 to December 2009. 1029. The mean age of the study sample was 50.5 +/- 12.1 years. Fifty two percent study participants were males and 48% females. They were from various occupations, educational levels and socio-economic strata. Among these diabetics, 73% had family history of diabetes; 20% were doing exercise, 20% knew self monitoring blood glucose and 6% had knowledge to inject insulin. Only 29% followed diabetes diet. A vast majority of diabetic patients was not doing exercise; had least knowledge of self monitoring blood glucose and did not follow diabetes diet. Various environmental factors, lack of related information and peoples' reluctant attitude played important role in the high prevalence of diabetes

Transabdominal preperitoneal laparoscopic inguinal hernia repair

To determine the outcome of transabdominal preperitoneal [TAPP] inguinal hernia repair. Descriptive study. At Surgical C Unit, Khyber Teaching Hospital Peshawar, from April 2010 to June 2011. A total of 88 patients, aged between 16-60 year were included in the study and subjected to transabdominal preperitoneal inguinal hernia repair. The outcome measures such as operative time, length of hospital stay and postoperative complications were analyzed. The mean age of patients was 38.64 +/- 9.04 year. The mean operative time was 60.13 +/- 14.76 minutes. The mean hospital stay was 1.45 +/- 0.72 days. The postoperative complications were urinary retention [n=1 - 1.1%], wound hematoma [n=1 - 1.1%], surgical site infection [n=2 - 2.2%] and recurrence of hernia [n=1 - 1.1%]. Transabdominal preperitoneal inguinal hernia repair is associated with minimal complications but requires a long learning curve

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

effect of dexamethasone on neuropraxia following third molar surgery

In this double blind controlled study, the effects of intramuscular Dexamethasone on neuropraxia development of inferior alveolar nerve and lingual nerve following the surgical removal ofmandib ular third molars were studied after 24 hours. Patients who were contraindicated to the use of steroid i.e. hypertensive, GIT ulcer, diabetics, bacterial infections, history of thromboembolic events, psychosis, patients taking other medication chronically and pregnant were excluded from this study. Out of total 200 hundred impactions cases, 100 cases received 8mg intramuscular dexamethasone one hour prior to surgical extraction but it was not given to other 100 cases of control group. The overall rate of paresthesia of lingual nerve was 15% and of the inferior alveolar nerve 6.5%. On comparison no statistical difference in neuropraxia within the dexamethasone group and control group was noted. P value for lingual nerve was 1.000 and for inferior alveolar nerve 0.390 so both had no significance statistically [p>0.05]

survey to assess the female sexual harassment in the higher educational institutes of Karachi

To determine the nature and frequency of the exposure of female students to sexual harassment at higher educational institutes; and explore the adverse effects of sexual harassment on the victims and coping strategies implied by them. Sexual harassment, whether at workplace, educational institution, street or leisure is a problem gaining increasing recognition in every society. Despite the widespread nature of the problem, there are still considerable misunderstandings as well as differences of opinion concerning whether particular situations or behaviours are sexually harassing in nature or not. The victim may feel threatened, humiliated, harassed, and would interfere with the performance, satisfaction, commitment, and undermine security, or create an intimidating environment. This study was conducted in ten institutes which included six medical, three engineering and one general colleges/universities of Karachi from January 6 to September 30, 2009. A total 480 female students were conveniently selected from ten different educational institutes, and were provided a self administered questionnaire with their consent. The identify of all the study subjects was kept secret. Out of total 480 female students, 460 i.e. 96% returned the filled questionnaire. Among them, 65% reported of sexual harassment of various degrees / levels irrespective of their residential area, appearance and attire. These females were harassed by the fellow students [37%], faculty [32%], and strangers [64%] who included patients, attendants, visitors and passerby. Although almost all of the participants [98%] wanted a punishment for the harassers, yet they [78%] were reluctant to disclose the name/ identity of those perpetrators because of the fear of exploitation, social taboo, further embarrassment, adverse consequences, and career obstacles. Many females were the victim of sexual harassment in various forms. There is a need to sensitize the society; and mass awareness programs should be carried out through variety of media

Is medical expulsive therapy an option for ureteral calculi?

To compare tamsulosin with simple observation in terms of lower ureteral stone expulsion. Randomized controlled trial. Surgical C unit, Department of surgery, Khyber Teaching Hospital Peshawar, from February 2008 to January 2009. The patients were divided into two groups. Group A patients were offered medical expulsive therapy [tamsulosin] while group B patients treated with observation receiving analgesics only. Data regarding age, gender, stone expulsion rate and time, and analgesic requirement were collected and analyzed. Frequency and percentages were calculated for categorical variables while mean +/- SD was used to express continuous variables. Chi square test and Student t test were used to compare categorical and numerical variables respectively. After randomization, 56 patients in group A and 55 patients in group B were analyzed. The mean age of patients in group A and B was 37.37 +/- 7.51 years and 37.90 +/- 10.34 years, respectively [p 0.756]. The mean stone size was 6.39 +/- 1.78 mm in group A compared to 6.47 +/- 1.71 mm in group B [p 0.81]. In tamsulosin group, for stone size of 5mm, 48 [86%] patients expelled the stone, while for the same stone size, expulsion noted in 30 [56%] patients in the observation group [p 0.001]. The expulsion rate in group A and B, for stone size of more than 5 mm, was 91% and 38%, respectively [p<0.001]. The mean time taken for stone expulsion was 8.32 +/- 2.73 days in group A and 12.23 +/- 2.12 days in group B [p<0.001]. Patients taking tamsulosin experienced significantly less pain attacks compared to patients on observation therapy [p 0.017]. Alpha blocker [tamsulosin] is a safe and effective treatment modality for distal ureteral stones of appropriate size

comparative study on resistance pattern of pathogenic staphylococcus aureus against imipenem, methicillin, and vancomycin

Objective: The objective of this study was to evaluate current susceptibility of pathogenic isolates of Staph. aureus against imipenem, methicillin and vancomycin

Methodology: Antibacterial activity was performed using disc diffusion technique

Results: The average zone values were compared by using ANOVA and result found to be significant with p-value <0.001. Highest zone values were found to be 31.36+/-5.14 for imipenem followed by methicillin 23.77 +/- 6.53. The lowest zone value were found to be for vancomycin i.e; 14.76 +/- 4.30. Imipenem was the found to be the most effective drug as 91.67% isolates were susceptible to imipenem. While high degree of resistance was observed among isolates against vancomycin [83.33%] and methicillin [70.83%]

Conclusion: Increase in resistance demands the development and rational use of new, safe and effective therapeutic agents